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Malarone or Mefliquine

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  • Malarone or Mefliquine

    I'm nervous about the long term effects to my lil guy from taking 2-3 years of Mefloquine. I know that use of Malarone under 22lbs is off label. Does anyone know more about use of either med with a 9 month old / 18 lbs? Also, if anyone knows if either are a problem for a nursing mom? I had two ID Pediatricians give conflicting advice as to which I should take. My lil guy is just starting solids and is still 99.9% on breast milk. Thank you!

  • #2
    Siceland:

    Unfortunately we don't know much about the long-term exposure of infants to Malarone or Mefliquine.
    Below is what we do know about levels of Malarone and Mefloquine.

    I think the risk of exposure to these drugs, much be weighed against exposure to malaria. I cannot tell from your email if you are in a endemic area, or the USA.

    If the former, they may actually "partially" protect your infant.

    I'm sorry, I can't really advise you as to the long-term risk benefit ratio in this instance.

    Tom Hale Ph.D.




    -------------Malarone---------------

    Atovaquone and Proguanil hydrochloride is a drug combination indicated for use in falciparum malaria.[1] Atovaquone + Proguanil drug combination is a fixed combination of atovaquone (250 mg) and proguanil (100 mg) (adult dose). The pediatric chewable tablet contains atovaquone (62.5) and proguanil (25 mg). It is used both to prevent and treat malaria, particularly malaria resistant to certain other drugs. Both adult and pediatric formulations are available for treating pediatric patients down to 11 kg. No data are available on transfer of atovaquone into breastmilk. Only trace quantities of proguanil were found in human milk. Further, while the pharmacokinetics of proguanil is similar in adults and pediatric patients, the elimination half-life of atovaquone is much shorter in pediatric patients (1-2 days) than in adult patients (2-3 days). Elimination half-life ranges from 32 to 84 hours for atovaquone and 12 to 21 hours for proguanil; the half-life of cycloguanil is approximately 14 hours. For current information contact the CDC web site @ (www.cdc.gov). According to the CDC, breastfeeding mothers with infants less than 5 kg should use mefloquine instead of atovaquone + proguanil.[2]

    -------------Mefloquine -----------

    Mefloquine is an antimalarial and a structural analog of quinine. It is concentrated in red cells and therefore has a long half-life.[1] Following a single 250 mg dose in two women, the milk/plasma ratio was only 0.13 to 0.16 the first 4 days of therapy.[2] The concentration of mefloquine in milk ranged from 32 to 53 ?g/L. Unfortunately, these studies were not carried out after steady state conditions, which would probably increase to some degree the amount transferred to the infant. According to the manufacturer, mefloquine is secreted in small concentrations approximating 3% of the maternal dose. Assuming a milk level of 53 ?g/L and a daily milk intake of 150 mL/kg/day, an infant would ingest approximately 8 ?g/kg/day of mefloquine, which is not sufficient to protect the infant from malaria. The therapeutic dose for malaria prophylaxis is 62 mg in a 15-19 kg infant. Thus far, no untoward effects have been reported.

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    • #3
      Thanks, Dr. Hale.

      We've decided to put our lil guy on Mefliquine but I received differing advice as to whether I should then be taking Malarone or Mefliquine (one doctor said one and another said the opposite). I'm trying to figure it out. Any advice from you on this is very much appreciated.

      Also, as my son is just starting to try solids, will I need to adjust his dose as he begins to nurse less in the coming months?

      (I am moving to an endemic area in Africa)

      Many thanks!

      Stephanie
      Last edited by Siceland; 07-07-2013, 08:04 AM.

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      • #4
        Siceland:

        I would go to the CDC site and determine what drug is best for the AREA in Africa you are going. Then I'd try and decide between the two above. But it looks like from the data that Mefliquine is the better choice. You might also confer with physicians down there when you arrive. They may have a better sense for this therapy.


        Good luck

        Tom Hale Ph.D.

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        • #5
          On the Gambia site I should say malarone is recommended more by posters than larium,personally I did not like malarone had a bad side effect I found larium fine one a week and I take 1 for 2 weeks before I go ,I buy in the UK ,gauranteed not to be a fake

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